We report 15 cases of paranasal sinus mycosis treated by surgical therapy at the Department of Otolaryngology, Kagawa Medical University, between October 1986 and September 2001. The patients (3 males and 12 females) ranged in age from 33 to 77 years, with a mean age of 59.1 years Twelve patients had mycosis in the maxillary sinus, 2 in the sphenoid sinus, and 1 in the maxillary and ethmoid sinuses. All cases were unilateral.
The mycosis diagnosis was confirmed mainly by pathological examination. Aspergillus was detected in 13 cases, mucor in 1 case, candida in 1 case. CT and MRI examinations showed an irregular shadow in the sphenoid sinus and partial bone destruction of the sinus wall. Five cases were treated using Caldwell-Luc's procedure, 7 using endoscopic sinus surgery and 2 by endonasal antrostomy. The prognosis was good in all cases.

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We report a case with unilateral nasal obstruction and double vision due to a verrucous carcinoma originating in the left ethmoid sinus. A 69-year-old man with a left nasal mass covered by necrotic tissue was found in computed tomography to have a mass in the left ethmoid sinus that extended to the left side of the frontal sinus and nasal cavity, with bone destruction of left orbital wall and cranial basement. Magnetic resonance imaging showed dura mater adjoining the tumor to be enhanced by gadolinium-DTPA. Although a biopsy specimen was diagnosed as squamous papilloma, we suspected the possibility of a malignant tumor based on CT and MRI results. We surgically resected the tumor, approached from the anterior cranial fossa. We reconstructed the cranial basement using a free rectus abdominis myocutaneous flap. No tumor recurrence has been seen in the 10 months since surgery.

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In this study, we investigated the clinical efficacy of conservative treatment of the middle meatus in patients suffering from acute rhinosinusitis. Twenty-four patients (11 male and 13 female) between the ages of 16 and 83 years (mean: 42.5 years) were enrolled in the study. The patients were assigned to two groups; the first group received cotton treated with epinephrine and placed in the middle meatus to improve paranasal sinus ventilation; the second group did not receive epinephrine. All other treatments were identical for the two groups. Two weeks after the start of treatment, the nasal symptoms of the patients were examined. After four weeks of treatment, a computed tomography examination of the maxillary sinus was performed. The results of the present study suggest that it may be clinically worthwhile to widen the middle meatus in patients suffering from acute rhinosinusitis.

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We report a case with primary multiple cysts in the frontal sinus showing intracranial development. Despite of the lesion's large size, the patient suffered only slight exophtalmos. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed that cysts oppressed the right frontal lobe of the cerebrum, but no symptom indicating frontal lobe impairment was noted. Endoscopic sinus surgery using a microdebrider was conducted and cysts opened to the nasofrontal duct without complications.

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Transnasal endoscopic repair has been increasingly used to treat patients with cerebrospinal fluid (CSF) rhinorrhea. We describe two such cases, one with recurrent idiopathic cerebrospinal fluid rhinorrhea formerly treated in China and one with post-trauma. We took an endoscopic transnasal approach. The postoperative course of patients was good and no recurrence was observed. Endoscopic repair of CSF rhinorrhea is minimally invasive and useful because it can be done under direct vision with endoscopy. The fistula site and size should be accurately determined preoperatively and an appropriate surgical approach chosen in treatment.
Transnasal endoscopic repair is useful and should be considered as the treatment of choice.

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The elderly often report watery rhinorrhea without other symptoms. Allergic rhinitis is not common in individuals aged over 65 years. The color of nasal mucosa in the elderly is not usually pale, and antigens are not identified. Taken together, such nasal discharge is usually non-allergic and called “old man's drip.” The mechanism behind it is not fully understood. To determine the demographic data on patients with this condition, the concerns of physicians treating it and actual patient management, we sent questionnaires to 124 oto-laryngologists, with a response of 58% (64). Most were not familiar with the term “old man's drip.” Although nasal discharge was a leading symptom in the elderly, and 10 to 30% of patients reported rhinorrhea, less than 30% of these suffered from allergic rhinitis. Chronic rhinitis, vasomotor rhinitis, and chronic sinusitis were often used in tentative diagnosis. Fewer than 50 patients with old man's drip consulted a clinic each year. Antihistamines were most frequently prescribed for these patients, followed by antiinflammatory enzymes and anticholinergic nasal drops. The elderly are, however, specifically at risk from complications of such drugs.
Atrophic change in nasal mucosa becomes apparent in the 60's, lowering mucosal temperature in the nose and nasopharynx and diminishing heating capacity. Water reabsorption from nasal mucosa becomes incomplete in expiration and water droplets remaining on the surface may increase. Condensed water cannot be used for humidification in the next inspiration because of the lower heating potencial of nasal mucosa, causing nasal drip after water droplets collect. Water provided by vascular leakage but not glandular secretion appears to be dominant in nasal drip. Nasal drying caused by medication also decreases air conditioning potential. Old man's drip often occurs during eating. Conditions differentiated from this condition are cold air-induced rhinorrhea and gustatory rhinorrhea, considered due to reflex parasympathetic activation of the nasal glands, and anticholinergics are effective. These are not, however, indicated for old man's drip, for which we suggest heating nasal mucosa resulting in increased water absorption during expiration.

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Acute and chronic sinusitis are major causes of olfactory disturbance. We evaluated 11 patients with olfactory disturbance who underwent endoscopic sinus surgery (ESS) to determine effects on olfactory disturbance.
Before and 3 months after ESS, a standard olfactory acuity test (T & T olfactometry or jet stream olfacyory test) and computed tomography (CT) were conducted to evaluate effects on olfaction. Olfactory improvement was correlated with ESS; effects on sinus pathology and findings of olfactory cleft estimated by CT. Cases showing improvement in both ethmoidal sinus pathology and olfactory cleft space were the highest in olfaction improvement. These results suggest that olfactory disturbance caused by chronic sinusitis is alleviated by removing inflammation around olfactory cleft and in the ethmoidal sinus.

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We present an unusual case of neuro-sarcoidosis associated with various manifestations. The patient was a 49-year-old female who noted birateral blurred vision due to ocular sarcoidosis initially. Later, she developed diabetes inspidus, dysosmia, taste disorder and facial nerve palsy. Systemic administration of corticosteroid medication resulted in resolution of these symptoms. These results suggest that it should be taken into consideration dysosmia is one of the clinical symptom in sarcoidosis.

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Hereditary hemorrhagic telangiectasia, usually called Osler disease, is associated with telangiectasia, recurrent epistaxis, and a family history of the disease. Mild to severe recurrent epistaxis is the most common symptom, making it difficulty for many otorhinolaryngologists to treat recurrent epistaxis successfully. We treated an Osler disease patient presenting recurrent epistaxis for over 10 years, using hormone therapy, microembolization, and laser therapy with temporarily good effects, but hard epistaxis recurred less than 1 year after treatments.
We then combined alcohol sclerotherapy with laser therapy. At present there are no reliable methods for curing Osler disease, and only allopathy is used for treating severe epistaxis. We consider that alcohol sclerotherapy combined with laser therapy may be the most useful technique for improving patient quality of life (QOL) by inhibiting.

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